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CDM 3 Exam 3 > Lecture 2 - Transplant Complications > Flashcards

Lecture 2 - Transplant Complications Flashcards

(49 cards)

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1
Q

What makes you think rejection

A

Bump SCr = kidney
Bump LFTs = liver
HF symptoms, fluid overload = heart
Shortness of Breath = lungs

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2
Q

1st line for Acute Cellular rejection streatment

A

Steroids

Pulse dosing, based on organ
Generally 3 days +/- taper

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3
Q

2nd line therapy for Acute Cellular rejection treatment

A

usually refractory, used for severe rejection
Doses range based on organ

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4
Q

Last line for Acute Cellular rejection treatment

A

Alemtuzumab

For persistent severe rejection

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5
Q

Methylpred to Prednisone conversion

A

4:5

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6
Q

Corticosteroid monitoring when using for rejection treatment

A

watch Blood sugar, may req insulin
Trouble sleeping
Blood pressure
Admin high doses at least 18hrs apart

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7
Q

Treatment of AMR w/ Pulse steroids, Thymoglobulin, Belatacept works on…

A

T cell
APC

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8
Q

Treatment of AMR w/ Rituximab works on…

A

B cell

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9
Q

Treatment of AMR w/ Bortezomib works on…

A

Plasma cell

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10
Q

Treatment of ARM w/ Plasmapheresis works on…

A

antibodies

essentially removing antibodies

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11
Q

Treatment of ARM w/ Ecolizumab works on….

A

complement system

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12
Q

Treatment of ARM w/ IVIG works on…

A

all the parts

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13
Q

IVIG Adverse reactions

A

infusion reactions so need to premedicate

Hemolytic anemia when pts are non-O blood type

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14
Q

Rituximab dosing info

A

weight based dosing
Pre-medicate
Monitor for HepB reactivation

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15
Q

Bortezomib dosing info

A

Does m2
IV push has to be over 3-5 sec
SubCu can avoid infusion related reactions

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16
Q

Bortezomib monitoring

A

Hepatic function
Myelosuppression
Peripheral sensory/motor neuropathy

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17
Q

Eculizumab dosing info

A

varies depending on organ
IV infusion over 30 min

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18
Q

Eculizumab dosing info

A

varies depending on organ
IV infusion over 30 min

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19
Q

Eculizumab monitoring

A

Has REMS, pts req vaccination with meningitis vaccines or prophylaxis with abx for duration after therapy

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20
Q

Pharmacy concerns Eculizumab

Study These Flashcards
A

$$$$$
commonly non-formulary
Special order from drug company
REMS program

21
Q

2 way street to prevent infections

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A

Screen recipient and donor

22
Q

Pneumocystis (PJP)

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A

Risk related to time post transplant
All organs get prophylaxis initially
Duration organ/center specific

Preferred agent is bactrim

23
Q

PJP 1st line agent

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A

Bactrim
SS QD or BS MWF

False SCr elevation, leukopenia

24
Q

PJP 2nd line agent

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A

Atovaquone
1500mg QD

$$$$
“yellow paint” liquid

No renal dosing

25
PJP 3rd line agent
Dapsone 100mg QD No renal dosing Check G6PD, risk for methemoglobinemia High hematologic toxicities
26
CMV Risk factors
D+/R- = 56-80% D-/R+ = 0-27% D+/R+ = 27-39% D-/R- = < 10% small bowel,liver,lung at highest risk
27
CMV prevention
minimum of 200 days = Valganciclovir = renal dose adjustment
28
CMV symptoms
Flue-like = Diarrhea,fever, malaise Leukopenia** viral phenotype Colitis** most common CMV disease
29
1st line for CMV
Gamciclovir = IV, use if concern for oral absorption Valganciclovir = oral most common SE Thrombocytopenia/Neutropenia
30
1st line in UL97 resistant CMV
Foscarnet
31
Foscarnet info
extremely nephrotoxicity aggressively pre-hydrate monitor for electrolyte abnormalities
32
Treatment of CMV
reduce immunosuppression = d/c dose of mycophenolate if possible Monitor CMV viral loads weekly Renal dose adjustments in all 4 drugs
33
Letermovir info
doesn't cover HSV, use with Acyclovir CYP3A4 inhib*** = tacrolimus lvls role emerging for prophylaxis CMV in pt who cant tolerate valganciclovir AE = GI + Peripheral edema
34
Maribavir info
oral, weak inhib of CYP3A4 Doesn't cross BBB but does cross blood-retinal barrier ADE: Dysgeusia, Diarrhea, Nausea, Vomiting, Fatigue Typically for treatment resistance disease
35
Prophylaxis CMV treatment
start valganciclovir if leukopenia concern, watchful waiting vs letermovir avoid maribravir and wait for CMV vaccine
36
Treatment-Viremia CMV
1st line ganciclovir/valganciclovir monitor response if concern for resistance consider new agents
37
Treatment - Resistant Disease CMV
consider Maribravir depending on disease dissemination
38
Candida fungal prophylaxis
Nystatin = 1st line for oral Fluconazole as backp
39
Aspergillus fungal prophylaxis
Oral azole close monitoring of tacrolimus
40
1st line therapy or severe fungal infection
liposomal ampotericin
41
Ritonavir w/Tacrolimus when treating COVID w/ Paxlovid
Ritonavir effects Tacrolimus so have to hold immunosuppression once starting therapy such as paxlovid
42
vaccines that should be avoided in immunocompromised patients?
Live vaccines are CI post transplant Give pre-transplant
43
Infection prevention living tips
frequent hand washing avoid smoking avoiding well water no raw/undercooked foods avoid public buffets or street food avoid cleaning animal cages
44
transplant Hypertension treatment of choice?
CCB = amlodipine/nifedipine ACE/ARB consider if proteinuria/DM, 1yr out and more stable
45
Transplant Hyperlipidemia treatment of choice?
Cyclosporine has more effects with statins than tacrolimus Only can use pravastatin with cyclosporine atorvastatin ok with tacrolimus
46
What pain med should be avoided after transplant?
Avoid NSAIDs, just Tylenol/acetaminophen
47
New onset diabetes after transplant info
Renal dosing of therapeutic agents Insulin = new regiment for pts Consider SGLT-2 inhibitors Hypoglycemia risk with decrementing steroids
48
Osteoporosis post transplant info
renal dosing for therapeutic agents Calcium supplements, but that affects Myclophenolate absorption
49
Gout post transplant info
DI: Taco inc colchicine conc*** allopurinol/Azathio also interact*** Allo is CI Febuxostat Avoid NSAIDs Pulse steroids typically treatment for gout attack

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